Stop Type 2 Diabetes

August 1st, 2012

Insulin resistance is your body's early warning system. Look for it to find out if diabetes has its foot inside the door.

By Craig Gustafson

Your doctor says that your fasting blood glucose (FBG) is “normal,” but nonetheless, a concentration of 90 mg/dL is above last year’s result. He sends you home with a clean bill of health; should you dismiss this as casually as your doctor did?

At 90, your score has not reached a level (at 100 mg/dL) that triggers the warnings that the “prediabetes” classification was designed to deliver. From a traditional medical perspective, reaching a plateau at 90 is not the worst thing in the world. The only problem is that it rarely stays there.

Common medical practice ignores a score of this magnitude, or even applauds it for being much lower than the threshold for a diabetes diagnosis. However, by the time your scores reach 90, the first domino in a predictable progression of events has started to fall. You haven’t reached the catastrophic point at which the doctor will take evasive action; however, you are more than likely seeing the effects of insulin resistance starting to manifest. This means metabolic syndrome—with its increased risk factors for a host of serious conditions—lurks right around the corner.

Research reveals that above a FBG concentration of 83 mg/dL, risk of heart disease and onset of diabetes rises significantly. So “normal” can be considered anything at or below this point. By the time your FBG reaches the mid-90s, your risk of developing diabetes within 10 years has already shifted from likely to probable. A reading of 90 mg/dL means that it is time to make some changes before severe damage is done.

For those who have already reached the point of being labeled diabetic or prediabetic, these same changes will benefit you, too, restoring your own body’s ability to manage glucose and weaning you off medications on which you may now depend. Despite what you might think, you have the power to reverse this condition and it does not require body-damaging drugs to do it.

The Dietary Puzzle

To understand insulin resistance, you first must let go of some cherished misconceptions about food that have been embraced over the past 40 years.

Only three macronutrients exist on our palette for consumption: proteins, fats, and carbohydrates. For decades, the health-conscious message Americans have heard is that fats are bad, red meat causes high cholesterol and cancer, and protein is hard on your kidneys. Consumers have been told repeatedly to reduce consumption of these foods. Current standards for protein and fat consumption provide for enough to prevent deficiency issues, but not much more.

The FDA’s MyPlate program currently recommends 60 to 75 percent of consumption as a mix of vegetables, grains, and fruits, and although these may contain a small amount of fat, the program is overwhelmingly weighted toward carbohydrates. The Center for Disease Control is more balanced in recommending that 20 to 35 percent of the diet consist of fats, but it still sets an upper limit for carbohydrates at 65 percent.

Food-product marketing often promotes “whole-grain goodness” packed into hundreds of products in the grocery store. Despite the healthy claims, these products are still carbohydrates and whether they are refined or not, carbohydrates still break down into simple sugars, primarily glucose.

If these carbohydrates are so healthy for us, then why have diabetes cases risen explosively in the decades since we demonized fat and protein and pushed carbohydrate consumption to nearly 60 percent of our diets?

Overconsumption of carbohydrates floods our bodies with the simple sugars glucose and fructose, overwhelming or confusing the response mechanisms designed to regulate blood sugar. As a result, your body begins to work against itself in order to survive.

Your brain is the most energy-consuming organ in the body, but it is also extremely sensitive to changes in the bloodstream. The blood-brain barrier isolates the brain from most substances in the bloodstream, but glucose—the brain’s primary fuel—crosses freely. Too much glucose is toxic to nerves, and neuropathy is one of diabetes’ signature symptoms.

The hormone glucagon signals the liver when glucose levels get too low, which then dumps glucose into the bloodstream from its reserves of glycogen (long strings of linked glucose) to keep levels sufficient. Insulin complements glucagon, spurring the uptake of glucose from the bloodstream and lowering blood concentration when it is high.

Insulin receptors in the outer membranes of muscle, liver, and fat cells bond with the hormone, which allows glucose to cross through the membrane into the cell. Cells use glucose for energy in both growth and daily activity. They also convert a small amount into glycogen as a reserve on the cellular level. Once these needs are met, the cell has no further need of additional glucose.

Make no mistake, your body is de signed to handle a certain amount of glucose to operate at peak efficiency. However, dietary choices often make much more glucose available than the cells need. With continued high glucose in the bloodstream, the pancreas continues to push insulin at the cells, which respond to the barrage by reducing the number of receptors available. With fewer places to go, glucose binds to proteins in the bloodstream instead, renders hemoglobin unable to carry oxygen to the cells (the percentage within blood is measured by the HgA1c test), or creates highly inflammatory molecules (advanced glycated end-products) that spur the progression of dysfunction throughout the body. This manifests as heart disease, high blood pressure, plaque-filled arteries … all the symptoms of metabolic syndrome.

Sweet and Deadly

Table sugar, sucrose, is particularly troublesome. It consists of one glucose molecule bonded to one fructose molecule, which throws a particularly potent one-two punch at your body. While every cell in the body can metabolize glucose, fructose is broken down exclusively in the liver and does not induce insulin production. About one-third of the fructose you consume becomes substances that damage your body in some way: very low density lipoproteins (bad cholesterol) that damage blood vessels and induce the formation of plaque, free fatty acids that enter cells and induce insulin resistance (within the liver and skeletal muscle), uric acid that reduces levels of nitrous oxide that is critical in regulating blood pressure, and additional transformation of free fatty acids into triglycerides (fat) that accumulates in cells. When this fat is deposited in the liver, nonalcoholic fatty liver disease is the result and this, too, ramps up insulin resistance.

Remember, some fructose is okay, but today’s diet provides a tidal wave of it through consumption of fruit juice (one glass has all the fructose of several whole fruits and none of the fiber that slows its absorption) and high-fructose corn syrup, which is engineered to mimic the one-to-one glucose-fructose proportion of table sugar. One other note on fructose consumption: According to the work of Dr. Robert H. Lustig, professor of pediatrics in the Division of Endocrinology at University of California San Francisco, your liver metabolizes it in the same way as it metabolizes alcohol—and there is no disputing the damage done to the body by overconsumption of alcohol.

Is Diet the Only Factor?

While diet certainly plays a key role, there are other factors that trigger insulin resistance.

Along with insulin, cortisol is one of your body’s primary hormones. It is involved with survival response and, in that role, temporarily hijacks the body’s metabolism. Short term, this response is developed to help you through stressful situations, such as evading danger or hunting for food. However, stress has evolved from isolated situations into a constant barrage that keeps the cortisol running nearly continuously through our bodies.

Chronic cortisol exposure contributes to insulin resistance in several ways: It increases insulin in your bloodstream (which in the case of emotional stress, does not get burned off through physical exertion). It increases hunger—for sugar in particular, and the impact of that has already been described. It raises fatty-acid and triglyceride levels, and increases abdominal fat. All of these effects feed into the progression that increases insulin resistance.

Another trigger for insulin resistance is inflammation. While diet can certainly cause inflammation (high blood-glucose concentrations can be the result of inflammation, and at the same time cause more inflammation—a deadly double whammy), other sources of inflammation can be overly strenuous exercise routines, autoimmune conditions, obesity, and high cortisol levels (again, read this as stress) to name a few.

Environmental toxins are also capable of disrupting metabolism and causing insulin resistance. A study published in a 2008 edition of the Journal of theAmerican Medical Association found that higher levels of bisphenol-A in the urine of adult participants correlated to higher prevalence of cardiovascular disease and diabetes. This is just one toxin of more than 150 that were found to be present in a sampling of the adult population by the Environmental Working Group.

Am I Suffering from Insulin Resistance?

At the beginning of this article, FBG numbers lower than the generally accepted diabetes definitions were discussed as thresholds for dysfunction. By the time your FBG crosses 90 mg/dL, your body’s coping mechanisms have likely been working overtime to stem the tide and control your blood glucose levels. Pancreatic beta cells have been continuously churning out insulin at higher-than-normal levels and are just now starting to lose ground and slip into dysfunction.

Unfortunately, typical medical practice allows your body to nearly fail before it takes action, and this is reflected in the tests used to determine your health. The FBG test, as mentioned, does not register dysfunction until much of the damage is done and insulin resistance is well entrenched. The A1c also does not rise appreciatively until the same point in time. While these tests are good for monitoring the status of a known diabetic, they are not good diagnostic assays for insulin resistance.

To find out exactly where you are on the road to type 2 diabetes (or if you have turned things around and gotten off of it), there are a pair of tests that offer a much better perspective than FBG. A test for elevated insulin levels or an oral glucose-tolerance test can tip you off to a problem much earlier.

Fasting blood-insulin test (FBIT).

The presence of insulin resistance causes your pancreas to produce and release much more insulin in order to overcome lower sensitivity and normalize glucose levels. Taken after an 8 to 12 hour fast, this blood draw measures the actual amount of insulin floating in your blood stream.

As an advocate for using the FBIT, Ken Hampshire, formulator of the blood-sugar support supplement DiaMetrix, says that this test can open your eyes to what is happening within your body: “Hey, I’m under some stress here, and insulin resistance is causing my pancreas to secrete way more fasting insulin than it should be. That’s going to start causing havoc for me, if it hasn’t already.”

A score of five is an average score (three is better), while up to 10 can be considered tolerable. Scores approaching 10 indicate that you have some work to do and scores over 10 indicate elevated levels. A score over 15 can indicate hyperinsulinemia, although traditional medicine may label scores up to 20 as being in the “normal” range. Keep in mind, this is your body—you be the judge.

Oral glucose-tolerance test.

Rather than looking at your glucose levels when there is no fresh fuel in your system, the oral glucose tolerance test measures your body’s reaction to a sudden spike in blood sugar. After taking a fasting baseline blood sample, a drink of simple sugar is administered and additional blood samples are drawn at one and two hours to see how you cope with it. The conventional view is that after two hours, your blood sugar should be below 140 mg/dL. If your score falls in the range between 140 and 199, you are prediabetic while 200 or above indicates diabetes.

However, if the goal is measuring insulin resistance, those markers are set too high. Many integrative practitioners set a normal response (for a non-impaired individual) as starting from the sub-83 range identified earlier and rising into the mid 120s before dropping again. After a carbohydrate-rich meal, the peak reading should occur about 45 minutes after the meal begins. After two hours, the reading should be below 100 again, and for many people it may return to the baseline by this point. The key here is to observe the response to a meal and your body’s efficiency in dealing with it, rather than focusing on the exact starting and ending point.

A home glucometer can help you administer this test yourself and give you a rough idea of how your body is functioning. After an eight-hour fast (nothing but water), clean your hands and take a baseline reading with the home device. Eat 3.5 ounces of cooked white rice. Take additional readings with clean hands at 45 minutes, two hours, and each hour until your reading drops back below 100. Keep in mind that the home tests are not as accurate as a lab test, but this will be good enough to give you an idea of how your response is functioning.

Blood-sugar spikes above 140 are a cause for concern because at that point your pancreatic beta cells are dying. If you suffer from insulin resistance, these cells already can’t keep up, and now there are fewer to produce the necessary hormone level. This becomes a vicious cycle.

Combating Insulin Resistance

The earlier you move to take control of your metabolic process, the easier it will be to reverse. Type 2 diabetes, metabolic syndrome, and insulin resistance are dysfunctions of overabundance, rather than scarcity. Unlike type 1 diabetes, where blood glucose that is too low is a critical issue, a type 2 diabetic never has to worry about dangerously low blood-glucose levels—unless medications are used to control the situation. Not having to worry about the dangerous low side of the curve gives you great power over your condition if you choose to employ it.

What can you do to curb your insulin resistance?

Exercise. The progression to type 2 diabetes is characterized by abdominal fat, and dropping even 10 pounds can significantly reduce your risk for many of the associated conditions. However, the reason to exercise is not to burn calories—that is a happy byproduct. The reason to exercise is that it is one of the best ways to directly counter insulin resistance! As you are able, mix 30-40 minutes of aerobic movement into your day, and try to get several minutes of strenuous aerobic movement in four times each week. Strenuous exercise should leave you winded, but does not have to last long. Work hard for 30 seconds to a minute, then slow the pace for three to four minutes. Repeat this cycle two to six times as you are able. A good weekly routine also includes strength-building exercises twice a week.

Diet. Bring the macronutrients in your diet back into balance. Get your carbohydrates from fresh vegetables instead of packaged foods and white grains and powders, and eat them in balance with fat and protein. Introduce a reasonable amount of saturated fat back into your diet in combination with healthy fats, and eat quality proteins in reasonable amounts (breakfast is a particularly important time to have a full serving of protein). Keep in mind that a serving of meat is about the size of a deck of playing cards, or the palm of your hand. If your insulin/FBG levels are on the high side, you may want to strictly limit (or even eliminate) fruits and grains for a period of time to let your body recover from the constant over exposure. Once your readings have come down, you can rebalance your diet.

Supplementation. There are a variety of supplements that have been clinically shown to assist with getting blood-glucose levels down and help reduce insulin resistance. The next article in this series will explore these and also touch on some supplements that help you cope with the symptoms of diabetes.